In Maine, workers’ compensation, often referred to as a workers’ comp claim and third-party claims, is a legal process related to workplace injuries and illnesses. Workers’ compensation covers healthcare expenses and lost earnings for job-related injuries but doesn’t include compensation for pain and suffering. If your job-related injury is caused by someone other than your employer or that person contributed to your injury, you could be entitled to additional claims, known as a third-party claim, beyond workers’ compensation.
Whether pursuing a workers’ comp claim or third-party claim, Hardy Wolf & Downing will work for you to ensure you receive the compensation you are entitled to. If you’re seeking workers’ comp or a third-party claim for a work-related injury, here is your guide for seeking legal recourse and how we can help.
Workers’ Compensation in Maine
Maine law requires almost all public and private employers to have workers’ compensation insurance coverage for their employees. Workers’ compensation insurance is a state-mandated program that benefits employees who suffer job-related injuries, illnesses, or disease, regardless of fault. In fact, the program is designed to ensure injured workers receive medical care and financial support without needing to prove fault.
Coverage includes weekly compensation for the time lost at work and payment for medical services for the injured or afflicted, physical therapy, prescriptions, and any other related health costs. If you can’t return to work, vocational rehabilitation, such as job retraining or job placement, is also included in the coverage. Compensation to dependents if a worker dies due to a work-related injury or illness is also covered. Workers’ compensation payment is subject to a limit set by law and is the exclusive remedy for the coverage of work-related injuries by the employer.
What to Do If You Are Injured
If a job-related injury occurs, you have 60 days from the date of the injury to inform your employer, your supervisor, or someone from management. If the company has a healthcare provider, you must go to that provider for the first ten days of treatment. You can change health care providers after ten days, but you must inform your employer of the change and let them know who the new provider is.
After you have reported your injury, your employer is responsible for filling out a First Report of Injury form and giving you a copy. The insurance company will likely take a statement from you and then have 14 days to approve or deny your claim on behalf of the company or business. In case of a dispute, and your employer and insurance company do not want to pay lost wages and medical bills, a Notice of Controversy form must be sent to you and the Workers’ Compensation Board.
Dispute Resolution
Should a dispute arise overpaying your claim, you will be contacted by a Claims Resolution.
A specialist, commonly called a Troubleshooter, will try to resolve the dispute between you and your employer. Troubleshooters are Workers’ Compensation Board employees who provide assistance and information to parties who use the workers’ compensation system. If the Troubleshooter cannot resolve the dispute, then your claim will go to mediation, which brings all parties—you, the worker, the insurance company, and your employer—to resolve disputes voluntarily.
You can request a formal hearing if mediation fails to resolve the dispute. You are entitled to Worker Advocate services during mediation or any formal hearings. A Worker Advocate is a Workers’ Compensation Board employee who will help you prepare for and accompany you to mediation and formal hearings.
Third-Party Claims in Maine
If your job-related injury results from the negligence or wrongful act of someone other than your employer, then you are entitled to pursue a third-party claim—a type of work-related personal injury claim taken against parties other than the injured worker’s employer. These types of claims can arise when the injury is caused by a subcontractor, equipment manufacturer, or property owner.
Key Components Of Third-Party Claims
Third-party claims differ from workers’ comp claims in several ways. While workers’ comp is accessible regardless of fault, third-party claims require proof of the defendant’s negligence. This can make third-party claims more challenging. However, if successful, they can provide more benefits, covering medical costs, full lost wages, and non-economic damages like pain and suffering or emotional distress. An injured worker can also pursue both types of claims simultaneously. However, if successful, Maine law allows the workers’ compensation insurance carrier to seek reimbursement of the amount paid to the injured worker from any third-party settlement or judgment.
How Hardy Wolf & Downing Can Help With Workers Comp and Third-Party Claims
Coordinating workers’ compensation benefits and third-party claims is crucial to ensure all benefits and damages are maximized without jeopardizing either claim. Hardy Wolf & Downing can help you review your benefits and claim with our free initial consultation and determine if there’s a possibility for an extra claim.
Whether dealing with a workers’ compensation dispute or a third-party claim, we will navigate the system to ensure your rights are protected, and you receive the compensation you deserve for your injury. More importantly, when it comes to negotiation and settlement with the insurance company, we will make sure that the benefits calculated are the maximum benefits you’re entitled to under Maine law, including wage replacement, medical expenses, and any potential lump-sum settlements. To find out how we can help you with your workers’ compensation dispute or a third-party claim, contact Hardy Wolf & Downing today.